Fancy a tummy tuck with your summer break? There are now package deals that combine five-star luxury with low-cost cosmetic surgery in exotic locations. Sally Williams meets some of the takers. Photographs by Zed Nelson

Jayne Powell, 37, is going on a holiday in the sun and she is thrilled. It isn't just the chill winds and tiring work routine - she is a mental-health support worker - that make this trip to Malaysia a cheering prospect. This is to be a holiday that will transform her, a chance to do what the brochure eloquently describes as 'feel more alive'. (A picture of a young, lithe woman in a bikini splashing through turquoise sea confirms the point.)

She plans meticulously. She buys tanning lotion, sunglasses and sandals, beach bag, plus super-strength painkillers, five sports bras in different cup sizes and a bumper pack of XXL knickers. This is because Jayne is going on a holiday with a difference. She is going on a cosmetic-surgery holiday. It will involve sun, sea and an eight-hour operation. This holiday really promises to make her feel, on the outside at least, 'like a new person'.

The pairing of major 'surgery' and luxury 'holiday' may seem to embody a fundamental contradiction: a holiday typically involves relaxation, enjoyment, exploration, not surgery, severe pain, blood and a period of complete incapacitation. But increasing numbers of British people are signing up to package deals offering luxury accommodation in a luxury location, with a facelift thrown in.

Popular destinations are Cape Town, Eastern Europe, and tropical Cairns, in Queensland, Australia. Gorgeous Getaways, an Australian-based company, offers deals to Thailand, Malaysia and Australia. Since it was launched two years ago, it has catered for 250 clients, aged 19-60 plus, and has bookings until the end of 2006. About 70 per cent are British, the rest are from New Zealand, Australia and America.

'I'm amazed that people go for these deals,' says Dr Rajiv Grover, a consultant plastic surgeon and council member of the British Association of Aesthetic Plastic Surgeons (BAAPS). 'The notion of a holiday dilutes the fact that it's serious surgery. They [patients] look at it like a beauty treatment,' he explains. 'What people forget is that nobody feels like a holiday when they've just had an operation.'

So, what is the appeal? I ask Lennie Chua, the Asia manager at Gorgeous Getaways. 'The price. It is much cheaper than in the UK, and also the holiday. A lot of our clients like shopping. They buy a lot of fake copies - Louis Vuitton and Gucci.'

How did something that only 10 years ago was regarded as physically risky, prohibitively expensive and socially embarrassing become a holiday? 'Ten years ago, it was all about the stars and the film actors,' says Adam Searle, a consultant plastic surgeon and the president of BAAPS. 'It's not like that today.' Thanks to reality-television shows such as Extreme Makeover and Ten Years Younger, in which unhappy women are transformed by dramatic head-to-toe surgery, cosmetic surgery is now more acceptable.

Last year saw a 35 per cent increase in procedures, and now cosmetic surgery is moving into new arenas: birthday presents, honeymoon extras, prizes. Last year, Zoo magazine ran a competition for readers in which the winner won a breast augmentation for his girlfriend. This is the nub of the charge that critics level against the industry. 'Cosmetic surgery has become normalised,' says Susie Orbach, the psycho-therapist and author. 'It's seen as just something you can do.'

It is Saturday, March 4, and I meet Jayne at breakfast in the Sutera Harbour Hotel in Kota Kinabalu, in Malaysian Borneo. She is relaxing here for the weekend, at a five-star resort on the edge of the South China Sea, overlooking coral-fringed islands, before flying to Kuala Lumpur for surgery on Monday (part of Gorgeous Getaways' Rainforest Recovery Package). There, she will spend three nights in hospital and then two weeks recovering in a five-star self-contained apartment.

The first thing you notice about Jayne is her size - she is 17 stone, a size 22 with an enormous 44-plus chest - and this, Jayne says, is why she's here. 'If I go out, people don't speak to me, they speak to my breasts,' she explains. In fact, her body dictates her whole personality. She is soft and emotional underneath, quite shy, she says. But people expect her to be loud, greedy, lazy. 'I can run and people think, a fat person running?'

She started out quite slim. But things went pear-shaped after the children, a daughter, 19, and twin boys, aged 16. Then she had a hysterectomy nine years ago, and now she says her belly is so large she can't see her toes. 'I've tried dieting and exercising, but nothing works.'

So she gave up, which is why she's eating a 'Full English' and putting up with the disapproving looks. Cosmetic surgery will be her salvation, she says. She has fantasised about having it all cut off for about five years, but thought it beyond the likes of her, until she read about Gorgeous Getaways.

Her husband says he loves her the way she is, but 'to be honest,' she says, 'unless you're big you don't know what it's like.' Jayne runs through the surgery she will have as if rattling off a shopping list: tummy tuck, breast reduction, breast lift, liposuction to back, tummy, thighs, arms and neck. She worked extra shifts to pay for it: £10,000 including 14 nights at the Lanson Place Ambassador Row, the state-of-the-art apartment block. Back home it would cost £20,000-plus for the surgery alone.

But there is a downside. The cost may be in reach, but the location is far away. Jayne's husband couldn't afford to come and she is still red-eyed from crying into her pillow last night. 'I thought, what am I doing in this strange country?' She has never been abroad without her husband - and was so anxious, she travelled for 12 hours with £8,000 in traveller's cheques stuffed into her bra. She knew she had to pay the hospital direct, but didn't realise they take credit cards.

BAAPS sees it a different way. 'Cheap can be expensive,' cautions Dr Grover, who points out that complications may occur that are usually left to the British system to pick up. But Louise Gogan, the founder of Gorgeous Getaways, is keen to reassure. 'We have sent more than 160 British people through surgery, and have not had one complication in terms of surgery error or infection.'

Jayne recovering after surgery. The fat removed from her body is presented to her in two buckets

Jayne has already met her surgeon in Manchester, a few months ago, when he flew out to see prospective Gorgeous Getaways clients. But she hasn't actually signed a consent form yet. Gorgeous Getaways' policy is that no commitment needs to be made until after the client gets to Malaysia and visits the hospital and surgeon. But still, BAAPS sees this as rather fast. 'Where is the cooling-off period?' Dr Grover asks, adding that people might feel pressured into quick decisions, 'otherwise recovery won't be through in time for the return trip.' But Jayne is unbothered. 'I'm so excited. I just want to get in there, now.'

The Gorgeous Getaways experience starts the moment you arrive at the airport and are met by the Gorgeous Getaways girls whose job is 'customer service' - three parts chauffeur to one part companion. Clients quickly learn their names: Kathy Lim, 34, Faith Kim, 22, Wan Mahsuri, 33, and their boss on the ground, Lennie Chua, 29, a marketing graduate with the face of a Bond girl and a key phrase: No problem.

Her bedtime reading is The Seven Habits of Highly Effective People. Like the cult television show Charlie's Angels, the big boss controlling this fragrant task force is a voice on a speakerphone: Louise Cogan is based in Australia. The girls are instantly like-able. Their tone is complicit, oddly intimate, with that air-hostess knack of seeming personally thrilled at your choice of watermelon juice, and honoured to bring it to you.

Kim, a sweet-natured girl, whose real passion is the piano, brings a spiritual leaning to her customer service. Her father is a Christian minister. 'We are here to care for others and to serve them,' she smiles, demurely. 'And for me I find it happiest to see others happy.' They all live in Kuala Lumpur, and speak a dazzling range of mother tongues: Mandarin, Cantonese, Malay.

But everything about them seems designed to minimise differences and reassure clients that despite the temples, heat and odd habit of moped-riders of wearing their jackets back to front (it stops them ballooning apparently), they can still find English tea (from Hock Choon supermarket) and a branch of Marks & Spencer (Time Square). They wear corporate-style trousers and jackets and speak excellent English, with 'boob' featuring heavily in their lexicon. Why not breast? 'Too naked,' Chua says. 'Boob job sounds more playful.'

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It is Monday, the day of Jayne's surgery. Yesterday afternoon, at Kota Kinabalu airport, we hit a hitch. Our plane back to Kuala Lumpur was cancelled and we had to stay overnight in what Jayne describes as a 'horrible back-packers' pit', aka the Airport View Hotel, compliments of Malaysia Airlines. These things happen - on holiday - but it now means that Jayne is to rush from the airport to consultation, and then into theatre, after a sleepless night.

This blending of holiday and surgery is very odd. It's like having two Jaynes. The hospital Jayne and the holiday Jayne. Yesterday the holiday Jayne went for a stroll by the sea, marvelled at the jungle-covered hills and coconut trees, then ate lunch by the pool. Also, like many fair-skinned British tourists, holiday Jayne is suffering from sunburn (she forgot to put her factor 30 on her shoulders), an 'iffy tummy' and angry red mosquito bites on her legs.

But today we are in a consulting room in Ampang Puteri Specialist Hospital, and Dr Abdul Jalil bin Jidon, the head plastic surgeon, is drawing on hospital Jayne's sun-blasted skin like a graffiti artist. 'Is that tickly?' laughs a nurse, as the doctor marks the new nipple location (eight inches higher) on her soon-to-be pneumatic breast.

Ampang Puteri is a private hospital in the affluent eastern side of Kuala Lumpur, popular with ambassadors and the wealthy. Outside is typically tropical: 30C or so, with teeming streets, but inside is cool and hushed, with high-ceilinged corridors and polished floors. This ethereal feel is underlined by the nurses who are mostly Muslim and so wear nursing hats on top of the tudung, the headscarf, giving them the appearance of otherworldly picture-book queens or members of an obscure religious cult.

But their manner is playful, buddy-buddy, particularly the English-speaking ones. They say they make special British food: fish and chips, baked beans and frankfurters. What is the first thing British patients ask for when they come to? 'Kentucky Fried Chicken!' They are also enthusiastic about a particular cosmetic-surgery ritual: presenting patients out of theatre with buckets of their freshly collected fat, all cellophane-wrapped. 'I honestly thought I was getting a gift,' says one patient from Bradford, who is here having a tummy tuck and liposuction to her back.

'I thought, what is my gift? Then I realised. I thought, my God, it's taken me long enough to get rid of it, take it away!' Once they are out, Gorgeous Getaways clients meet up over tea or dinner and compare their litres. 'I had 3.6!' 'I had 4.2! More than Dr Jalil thought he'd get. He was quite chuffed with himself.'

The patients are allocated to a general surgical ward made up of individual rooms, overlooking tower blocks and clogged traffic on a flyover, with en suite bathroom and televisions linked to HBO and CNN.

Jayne is now in Room 517, in between an angio-gram and lung surgery. The head of the ward is Sister Ameerunnisa Hamid, a popular and motherly lady, who is well versed in Gorgeous Getaways principles. 'Guess how old I am?' she asks, taking me into a quiet corner near the laundry chute.

I look at her smooth face, her Tamil DNA evident in her high cheekbones and dark skin. I have no idea. 'Sixty last month, thanks to God, and the knife,' she confides, pulling back her scarf to reveal facelift scars behind her ears. 'I lost weight suddenly last year and my eyes went all droopy and crepey. I said, this won't do.' What's wrong with looking your age? 'No sweetheart,' she says, moving her head from side to side, 'that's the wrong concept. This is a competitive world. Everybody wants to look good.'

As well as being surgeon to Gorgeous Getaways patients, Dr Jalil, 50, has his own private list and a reputation as a surgeon to Malaysian stars. He also has a parallel career as a do-gooder, operating on congenital defects and facial cancers for free. This, plus his delicate hands - he started in paediatrics - reassures Westerners, who are happy to have him tinkering in their breasts. Indeed, many even consider him a heart-throb, even though he is tiny and has to have the operating table so low it only just skims the floor.

But he has a downto-earth aura, and wears jumpers and jeans (albeit Versace) rather than the pinstripe suits favoured by surgeons back home. Also, despite coming from rural Malaysia he has a Western rock-star edge, having been a medical student in Kuala Lumpur in the 1960s, and likes to play loud Black Sabbath or Rolling Stones during surgery. (He also drives a Honda NSX sports car and plays the electric guitar.)

His second wife, an air hostess, is the Face of Malaysia Airlines. Dr Jalil is also one of those high-energy people who needs only four hours' sleep a night (he often plays badminton from 11pm to 1am) and can work for hours at a stretch. This energy suits cosmetic surgery, or the version of it here, where procedures are piled up in one session, like job lots. Operations can last up to nine hours.

BAAPS is stunned. 'After four hours of anaesthesia your risk of complications goes up - you have an increased risk of wound infection, chest infection and thrombosis,' Douglas McGeorge, president-elect of BAAPS, points out. 'If doing operations of choice, you should do them in a four-hour window.' Dr Jalil argues, 'The length of surgery is not so important. Jayne is healthy. I checked when I saw her in the UK.'

Andrew William Burr, a spokesman for the Ampang Puteri hospital, adds, 'Malaysian healthcare standards are very high. We've never really had any medical problems [with our cosmetic surgery patients].'

By means of balancing and doubling, Dr Jalil is able to perform several major surgeries in one day, moving between Gorgeous Getaways patients, the sound of his Cuban-heeled boots on the corridors' polished floors echoing in his wake. Today he is checking up on Catherine, 62, a housewife from America who is recovering from a facelift, and Penny, 50, a journalist from England, who had a tummy tuck and liposuction. These routine operations give him pleasure. 'It is a chance to make a difference.'

But the excitement on today's list is a new nipple for Kalvanita Fortson, a 27-year-old from Texas, who is based in Iraq, as a government contractor, organising housing for the US army. Last year she had a botched breast reduction in Budapest (£2,200). The surgeon took too much off. She lost a lot of blood and her right nipple. So Dr Jalil is to reconstruct a new one out of skin from her vagina. Plus, augment her breasts, do some liposuction and a 'body lift' to pull up saggy skin - the result of dieting - on her arms, legs and back.

I meet up with her a few days later, in her hotel. Was she worried about having surgery again?

Jayne inspects scars and bruising several days after her operation

'I prayed about it, so I knew everything would be OK.' She is swollen, with scars running like zips down the inside of her arms, and walking painfully slowly, but is happy, road-testing a new Halle Berry low-cut look. 'I feel sexy, not shy any more. I used to be so shy. I'm satisfied.'

His next case is Jayne, who is now an anaesthetised body in the operating theatre. Somehow, in this context, she is magnified. She is Gulliver in Lilliput, a Moby Dick among minnows. She couldn't look less like the tiny theatre assistants with their minuscule hips and slight, pre-pubescent-type bodies.

Every time Dr Jalil touches her, her body wobbles. Most Western clients are here to get the fat from well-fed bodies surgically removed, and I speculate what these pared-down people think of all this pinky-white flesh travelling so far to off-load in a tropical setting. Particularly when Dr Jalil rolls her tummy away to reveal a subcutaneous layer of white fat which he cuts out and drops in a kidney dish.

But, apparently, obesity is a growing problem here, too, thanks, partly, to the strengthening presence of Western fast-food outlets. There is a KFC, McDonald's and Dunkin Donuts just outside the hospital. Dr Jalil worked on Jayne from 5.30pm to 1.30am, to the accompaniment of Led Zeppelin, and a tropical storm, stopping only for a take-away pizza, cigarette and bottle of water.

There are six Gorgeous Getaways women recovering from surgery in four five-star hotels in Kuala Lumpur this week. (Clients typically leave hospital after two to three days.) Kim Huntley, 36, a beautician, with her husband, a property developer, is lying by the pool at the Legend Hotel, just opposite the Putra World Trade Centre. She has had a tummy tuck and liposuction because her post-children tummy 'looked an awful mess'.

She will wear her wrinkles with pride, she says; stretchmarks she couldn't take. Now she has a hip-to-hip scar in the shape of a smile, which Dr Jalil has not covered with dressing. 'Patients can have fun in the sun,' he says. She would, were it not for her swollen body encased in a compression garment - a giant elastic body stocking - crucial after liposuction, apparently, to flatten skin.

She is sweltering under her sarong, but has still managed to walk, slowly, to pick up some bargains at Mango and Topshop in the Twin Towers, where the air conditioning freezes sweat. Perhaps, this is why Gorgeous Getaways clients spend so much time shopping. It is the only cool place to be when your body has the bound-up look of a giant sports injury.

The real test of stamina for the Gorgeous Getaways girls is in the emotional minefield after surgery, when their vocabulary starts to include words such as 'stitch breakdown' and 'fluid build-up'. They make daily visits to clients, walking through the revolving doors of top-end opulence, to hand over painkillers and antibiotics and calm worries about chronic wind.

'One night I had a slight worry about a stitch,' Kim says. 'I was having an emotional day. I thought, oh no, it's infected. But Kathy came at 10.30pm to reassure me. She took me to see the doctor the next morning. She couldn't have done enough to help me.' BAAPS recommends resting at home, with no heavy lifting for at least six weeks after surgery. But Kim says it's easier convalescing here, among gold taps and white towels, than at home, with two dogs and two teenage sons to run after. 'I've missed my family, but we've kept in touch by webcam.'

Over in the neo-colonial splendour of the Mandarin Oriental Hotel, Sandra Hughes, 46, a housewife from Hampshire, with her husband, an electrical engineer, are sitting on plush sofas among potted ferns and a tinkling pianist, eating scones for tea. The only clue to Sandra's surgery five days earlier is a new bosomy look, sunglasses and a headscarf. And where better to use a headscarf to hide facelift scars, she says, than here, where lots of Muslim women are wearing the same.

Blonde and glamorous, with two grown-up children, Sandra is fighting the ageing process by wanting to 'look fresher'. 'It's hard being a woman in this era,' she says. 'Every magazine you pick up, women look a certain way.' But what is great about here, she adds, is there are no awkward explanations, because after all, everyone just thinks she's on holiday. 'I liked the fact that this is so discreet,' she explains. 'I haven't told anyone outside my family. It's my choice. What I'm doing is for myself, not for anyone to try and say no.'

Deborah Colley, 36, a policewoman from Australia, agrees. She has had liposuction to her legs, arms and tummy - 'I've had difficulties with my fat knees all my life' - over two surgeries, and filled three buckets. But officially, she's just lying by the pool: 'I shall say I've been exercising.'

It is now Friday, four days after Jayne's surgery, and she is out of hospital, but in a wheelchair. Although swollen, she is considerably thinner, with an incongruous perky chest, but her body is a war-zone of black, yellow and purple. Dr Jalil wanted to do the liposuction to her arms, legs and neck in a second surgery later this week, but she has had enough. 'It's really taken it out of me, to be honest. I didn't expect it to be like this.'

The money she is saving is funding a visit from her husband, who will arrive next Wednesday. 'Him not being here hurts the most,' she says. The Gorgeous Getaways team have seen it all before. 'It's normal to be a bit down in the first few days,' says Lennie Chua, who is cheering Jayne up with tea and toast. 'She will be happy.'

In the meantime, business goes on. There are more clients arriving today: Amber from Hawaii; Layla from Saudi Arabia; Linda and Annie, best friends from the UK. Plus there is the US market to grow. And there is talk of a competition for the best Gorgeous Getaways makeover. Cosmetic surgery holidays? No problem.

My friend went for liposuction in a private hospital in Melaka,she paid RM35,000.00 for area around her tummy and midriff.She was really slim but after 6months she is back to her normal size only the ugly scars remained.She never talked about it anymore.

Peristiwa

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